Ubogu Eroboghene E, Katirji Bashar
Division of Neuromuscular Diseases, Department of Neurology, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Hanna House 5th Floor, 11000 Euclid Avenue, Cleveland, OH 44106-5040, USA.
Clin Neuropharmacol. 2003 Mar-Apr;26(2):54-7. doi: 10.1097/00002826-200303000-00002.
An 85-year-old woman developed sudden confusion and dysarthria progressing to mutism, orobuccal dyskinesias, generalized tremors worse with activity, ataxia, and rigidity with cog wheeling without high-grade fevers or dysautonomia. These findings were related temporally to the institution of mirtazapine as monotherapy for a major depressive illness with superimposed anxiety disorder. Withdrawal of the agent resulted in early notable clinical resolution with only residual hypertonia after 2 weeks. This is a rare report of serotonin syndrome induced by mirtazapine monotherapy. The hypothesized pathophysiologic mechanism in this case is overstimulation of serotonin (5-hydroxytryptamine or 5-HT) type 1A receptors (5-HT(1A)) in the brainstem and spinal cord in an individual with risk factors for hyperserotoninemia resulting from reduced, acquired endogenous serotonin metabolism.
一名85岁女性突然出现意识模糊和构音障碍，进而发展为缄默、口颊运动障碍、活动时加重的全身性震颤、共济失调以及齿轮样强直，无高热或自主神经功能障碍。这些表现与使用米氮平单药治疗伴有叠加焦虑症的重度抑郁症在时间上相关。停用该药物后，临床症状早期显著缓解，2周后仅残留肌张力亢进。这是一篇关于米氮平单药治疗诱发血清素综合征的罕见报告。该病例中推测的病理生理机制是，在一名因内源性血清素代谢减少而具有高血清素血症危险因素的个体中，脑干和脊髓中的血清素（5-羟色胺或5-HT）1A型受体（5-HT(1A)）受到过度刺激。
